9 year old implants - fluid on breast. What causes this and will it go away on its own?

It would be appropriate to follow the recommendations from your MRI and consider fine needle aspiration of the fluid. There are many causes for development of a late seroma. The most significant is BIA-ALCL and this would be the way to diagnose or rule this out. For more information, discuss this with your surgeon or primary care physician.

Dear Rhinton1,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

There are many potential causes of peri-prosthetic fluid (fluid around the implant). Most are benign and of minimal significance.

BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) is a rare process associated with textured implants. the association is stronger among Allergan BIOCELL as compared to Mentor SILTEX devices. It typically presents as late onset swelling (often unilateral) with fluid confirmed on imaging.

Due to the potential (highly unlikely) for BIA-ALCL, prompt workup is recommended. This includes sampling of the fluid and immunohistochemical analysis (ALK and CD30 testing).

BIA-ALCL is very treatable and early explant/capsulectomy is curative.

With regards to your specific question, ultimately the prognosis will depend on the source of the seroma. It is best to begin with a workup.

As always, discuss your concerns with a board certified plastic surgeon (ABPS),

Rhinton1,
This is an important question due to the known association between textured implants and Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Siltex implants (textured implants made by Mentor) have a much lower reported association with BIA-ALCL than Allergan’s BIOCELL implants, but the risk isn’t zero. The key point is that new swelling or fluid around an implant — especially 8-10 years after surgery — should always be evaluated promptly to rule out ALCL. Here’s what I recommend:See your plastic surgeon right away (or a board-certified plastic surgeon familiar with implant-associated conditions).An ultrasound of the breast is the first step to check for fluid (a seroma) or any capsule changes.Since you have already had an MRI and fluid was found around your implant, it should be aspirated and sent for CD30 and ALK testing to rule out BIA-ALCL.Most of the time, swelling is due to benign causes (such as a small seroma, trauma, or infection), but it’s important to confirm.If BIA-ALCL is diagnosed, it’s typically treatable and curable, especially when detected early.
Dr Stein

A sudden size increase years after augmentation is most often due to fluid collecting around the implant. Common causes include a benign late seroma, small implant leak, low-grade inflammation or infection, and rarely BIA-ALCL in textured devices.
Your MRI recommendation for fine needle aspiration is appropriate. Ask your team to send the fluid for:• Cytology to look for abnormal cells• CD30 immunohistochemistry to screen for BIA-ALCL• Cultures if infection is a concern
If results are benign:• One-time aspiration may reduce the swelling, but recurrence is possible if the capsule keeps producing fluid• Recurrent seroma often responds best to capsule surgery with implant exchange or removal after a full discussion of pros and cons• If imaging shows implant rupture, implant replacement or removal is the solution rather than observation
Will it go away on its own?• Sometimes a small sterile seroma settles after aspiration and rest• If the pocket refills or imaging raises concern, addressing the underlying cause is safer than repeated waiting
The information here is not enough for a precise plan. A deeper review of your ultrasound, MRI report and lab results will define the safest next step. Our coordinators can help gather these details through a complimentary conversation if you would like to explore your options.
Wishing you clarity, reassurance and a smooth path back to feeling comfortable again.Güray Yeşiladalı, MD

First of all, great job in noticing a change in your breast and getting an MRI. A fine needle aspiration is recommended next to provide more information about the fluid, and the type of fluid will help determine treatment the exact treatment. There are many causes of fluid, including infection, inflammation, trauma, and the rare cancers ( Breast Implant-Associated Anaplastic Large Cell Lymphoma or Breast-Implant Associated Squamous Cell Carcinoma).
For most causes of fluid around a breast implant, additional surgery is going to be recommended. I therefore highly recommend that you schedule a consult with a plastic surgeon to establish care. She/he will be able to follow-up and explain your FNA results and help guide the process.
I can imagine feeling a lot of anxiety in your shoes, but I want to reassure you that there are non-cancer causes of a late seroma and getting the fine needle aspiration is a great next step!
Wishing you good luck and health,Dr. Renee Gasgarth